DRG Validator - Fully Remote

We are hiring for DRG Validators to join our team. We are seeking candidates who are extremely professional, have a strong coding background specifically in acute care hospital inpatient coding and have DRG analysis experience. A CCS is required for this position.

Hours: Flexible day shift- 40 hour weeks

Job Type: Direct hire

Job Title: DRG Validator

Pay: 80k-95k based on experience

Available Location(s): Remote

Overview

The DRG Validator is responsible for the quality review of inpatient coding (ICD-10-CM and ICD-10-PCS codes) to ensure accuracy and completeness of records coded by the coding staff for multiple clients.

The DRG Validator must validate the ICD-10-CM and PCS codes, principal and secondary diagnoses, DRG assignment appropriateness to ensure consistency and efficiency and to optimize DRG reimbursement and facilitate data quality in hospital inpatient services.

The DRG Validator reviews the physician documentation for specificity, completeness, and quality to support coding accuracy, and to identify physician query opportunities to improve the documentation.

The DRG Validator will follow the official coding rules, guidelines, and conventions to validate coded data and ensure high quality and compliance with regulatory requirements.

The DRG Validator works in conjunction with the Coding Manager of Revenue Integrity and the Director of Revenue Integrity to help develop coding education and training and institutional coding policies to achieve coding excellence and to enhance internal, proprietary software used as an analytical tool.

• Conduct MS-DRG and APR-DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification
• Expert knowledge of and the ability to: identify the ICD-10-CM/PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD-10 Official Guidelines for Coding and Reporting, and AHA Coding Clinic guidance
• Must be knowledgeable in the application of current ICD-10 Official Coding Guidelines and AHA Coding Clinic citations, in addition to demonstrating working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments
• Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing
• Writes clear, accurate and concise rationales in support of findings using ICD-10 CM/PCS Official Coding Guidelines, and AHA Coding Clinics
• Utilize proprietary workflow systems and encoder tool efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly
• Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements
• Maintain and manages daily case review assignments, with a high emphasis on quality

Requirements:

• Certified Coding Specialist (CCS)
• 3 years of acute care hospital inpatient coding and DRG analysis experience
• Someone who is flexible & open minded (needs to be comfortable helping out with coding as needed)
• High School Diploma or equivalent, Bachelor's degree preferred.

If you match the requirements, please apply today!!